The Maldives national football team is expected to face India for a friendly match in July ahead of next year’s Asian Football Confederation (AFC) Challenge Cup finals.
The match, expected to be played during the next few weeks at an unspecified location, will form part of India’s own preparation for upcoming qualifiers for the 2014 World Cup tournament, according to sports news website, Goal.com.
Back in March, the Maldives’ national stadium in Male’ hosted every single Group C qualifying match for the 2012 Challenge Cup, with the home team coming out on top to qualify for the finals alongside second place Tajikistan.
Following its qualification for the 2012 Challenge Cup, the Maldives is also expected to find out next week if it has been chosen as the tournament’s host nation. The tournament is contested two years every two years among a number of second tier national football teams represented by the AFC and has been held in 2010, 2008 and 2006 in Sri Lanka, India and Bangladesh respectively.
Cathy Waters is the new Chief Executive of Indira Gandhi Memorial Hospital (IGMH), the main hospital in the Maldives. She is one of three foreign medical experts brought out by the UK-based Friends of Maldives NGO and the Maldives High Commission to improve the country’s standard of medical treatment, alongside Medical Director Dr Rob Primhak and Nursing Director Liz Ambler.
JJ Robinson: How did your role at IGMH come about?
Cathy Waters: I’ve been on holiday to the Maldives many times, but it’s been a very different experience living and working here, compared to the sanitised version [of the country] you get at the resorts.
I knew nothing about Friends of Maldives – instead a friend of mine sent me an advert in the Health Services Journal, and said “This is the job for you.” I thought it was interesting, was interviewed in December and found myself out here very quickly, in February.
My background is 28 years working in the UK’s National Health Service (NHS), starting as a clinical nurse and working my way up. For the last 15 years I’ve been working in management, and the last eight as Chief Executive of a primary care trust, which commissions health care services.
I’ve had lot of exposure training and working in hospitals, as well as the broader healthcare system. I left the NHS three years ago and worked in a small management consultancy in the UK, which involved going into companies that were facing problems, and working with them to solve those and bring about change.
My last big contract involved working with big local authority in London than needed a transformational change. In reality it meant making significant savings – we had to make 80 people redundant.
JJR: What was your understanding and knowledge of what the position involved before you arrived?
CW: I understood that IGMH is one of five entities that comes under the umbrella of the Male’ Heath services Corporation (MHSC), IGMH being the largest entity, at about 90 percent.
I knew they needed to make significant changes to patient care, and the overall environment for patients. I knew IGMH needed change, which was part of attraction for me as it was somewhere I could utilise all the skills I had to bring about that change.
I also knew it was a hospital that people care passionately about. There’s a real sense that it belongs to the community and that we should be providing high quality services.
One of the things I noticed early on was that staff morale was very low, and people were unsure about what was happening with the organisation and had all sorts of concerns about the future. One of the things I did when I started was observe what going on and try to be very visible as a chief executive, spending time with the doctors and in the labour ward.
A new executive nurse director Liz Ambler is already here, and a Medical Director Dr Rob Primhak will be joining in July, so together we want to be able to demonstrate importance of management staff and clinical teams working closely together. We need to break down some of those barriers and reduce the divide between management and clinical services.
JJR: You arrived three months ago on the tail end of the collapse of the Apollo deal, a 15 year agreement signed in January 2010 with India’s Apollo Hospital Group to manage IGMH. What actually happened?
CW: I did read about Apollo. My understanding was that they wanted to bring about significant change but they wanted significant resources to do that, and that wasn’t an option. One of the things I’m very clear about is that we need to bring about significant change, but within the existing budget. That might involve reviewing everything we do as an organisation.
Unless we can find resources elsewhere we have to work within the budget we’ve got. That’s quite a challenge, because previously there may not have been the same budgetary controls [there are now]. We have to be careful how we utilise our very precious resources.
JJR: What parallels have there been so far with your earlier experience?
CW: Working in an organisation where there are significant financial challenges, and working in an organisation where patient needs are very clearly evident. The population is very vocal about what they want and need – some of that is about manging expectations.
One of the things I know we need address is that people can’t access doctors as quickly as they want. We need to increase outpatient appointments. At the same time there is no system of triage, or prioritisation of the emergency room, which we are now developing.
JJR: It’s true that many people claim the quickest way to get an appointment is to have the mobile number of a friendly doctor.
CW: We have a Maldivian ER consultant in training who is coming back to develop a triage system and ensure those patients who need to be urgently seen are seen straight away, or that those with minor ailments are seen by someone else, or not as quickly.
From what I understand there isn’t a word in Dhivehi that translates into ‘urgent’. We have quite a lot of work to do to make sure patients get to the right place at the right time.
One thing common to people working in the NHS and IGMH is that staff are passionate about what they do. We have to channel that in a positive way. We need to engage staff in decisions rather than it being a top-down management style.
This means helping them to be part of the decision making process, which can be difficult to get your head around. The key groups are patients and staff – happy patients mean staff are pleased they are doing a good job, equally, happy staff are more likely to perform well.
Sometimes it’s very simple stuff – such as saying ‘Thank you, well done.’ I don’t think that’s happened here very often. It doesn’t take a lot to say thank you.
The work that went into planning for mass causalities for the Friday of the recent protests was great. It was a really great example of working as a team and getting everything ready for an influx of casualties.
I recognised the hard work that had gone in so I made sure I came in on the Friday and was part of what was going on, so staff felt supported, and afterwards I wrote a thank you memo. Simple stuff like that makes people feel valued for what they are doing.
IGMH was gifted to the Maldives by the Indian government
JJR: What have been some of the key cultural challenges?
CW: There is a very, very different work ethic to the UK. Some of the things I’ve found very different and very frustrating are about how people manage their time, and motivating people to work. That’s a huge issue.
Getting people to plan ahead and put processes together is challenging. One exciting project is expanding the intensive care unit – I said we need a proper process and justification of the expansion, a proper plan about how we are going to do this. For me there’s a discipline to this, but it’s not always the way things have been done.
Also different and very distinct to IGMH is the lack of use of email – staff still attempt to use memos. I’m trying to encourage the use of email, and encourage people to think ahead and write agendas for meetings.
JJR: On other side of the cultural question, what has been the reaction among staff to a foreigner coming in as a top-level manager?
CW: Inevitably there’s been a degree of suspicion at someone new coming in, at someone from the UK coming in and imposing their views. For me what has been important is how we work with people and lead. I firmly believe that how you lead is important – working with staff, rather than telling them what to do. You do need boundaries and parameters, but people need a sense of direction, and permission to do things themselves.
The other issue is that my contract is for a year with the possibility of extending to two years. Whatever I do, I will feel I’ve failed if I haven’t managed to find someone in IGMH to transfer leadership skills to, and leave a positive legacy. The worst thing would be for me to do would be to go back to the UK and for things to tumble down. That would be an absolute failure on my part.
JJR: How did these obstacles come across? Were there initial difficulties?
CW: People have been very accommodating and very welcoming. I’ve convinced people that they don’t need to stand up when I walk into the room, which was very traditional, and I don’t expect people to call me “ma’am”. People generally been very welcoming. There’s been a few challenges with language barriers, although this has proved less of a problem than I thought it would be. I have very good support in meetings- I might do an overhead presentation, and it is translated into Dhivehi. Unfortunately I’m failing miserably at learn Dhivehi words. Generally people have been helpful and make sure I’m involved in what’s going on.
JJR: What are some of the unique characteristics of the Maldivian hospital-going public?
CW: They are very demanding, and very quick to blame the doctors if things go wrong. Inevitably in a hospital things go wrong, by the very nature of the work we do. And because IGMH is the country’s main hospital, we inevitably get the more complicated and high-risk cases. People are quick to be cutting.
Equally the general public should demand good care, and rightly get that care.
We need to work to enhance communication. One of the things I’ve noticed that is quite different from UK is that different departments still work in silos. We’re trying to break down these silos and get people to work across the organisation.
JJR: There has previously been conflict and misunderstandings between Maldivian doctors and foreign doctors working at the hospital, amid the cultural challenges of having a high turnover of foreign medical staff. Is this something you have observed?
CW: It fascinating that the hospitial talks about ‘Maldivian doctors’ and ‘foreign doctors’ as though they are completely different. Part of the problem I think for the Maldivian doctors who are very dedicated and are here for the duration is that they don’t get some of the benefits expatriate doctors get, such as support with their accommodation. Inevitably that brings some degree of conflict.
Expat doctors are also here for a short time, and I’m making a huge generalisation, but the commitment of some of them may not be as high as that of the Maldivian doctors. Some of that is the sort of contract we have for expatriate doctors, and that needs to be reviewed. Some of the expatriate doctors see IGMH as a staging post to get broader experience and go off to somewhere else, which must be quite annoying for the Maldivian doctors.
We’re trying to move to a position where as much of the workforce as possible is Maldivian, but inevitably that takes time.
JJR: What about the training of local staff, such as nurses?
CW: We have a good relationship with the Faculty of Health, and more Maldivian nurses are coming back into the system. Liz [Ambler] is very keen on in-service training to make sure we are training effectively, and Dr Rob [Primhak]’s background is in education so I’m sure he’ll be keen to ensure high standards of education and training when he starts in July. It’s an area we’re developing.
JJR: How have you found living in Male’?
CW: We’ve settled in well. My husband is semi-retired; he used to be a director of Mental Health Services. He’s made a decision not to work at the moment – he’s a diver and he’s doing his diver master training and really enjoying it.
One of my worries at the hospital is that we haven’t got the facilities to care for patients at the acute stages of mental health problems, and we haven’t necessarily got the right staff.
JJR: What do you think of the relationship the hospital has with the community, and what did the outcry over the widely reported ‘baby decapitation’ incident tell you about that relationship (the head of a deceased newborn had to be surgically removed during labour after its shoulders became stuck during delivery, endangering the mother).
CW: I had only been here a few weeks when that happened. Without going into the details, what surprised me was how quickly quite confidential details about the patient and the case were spreading like wildfire across Male’.
Understandably there was a lot of anger and concern, and fear generated. One of the key learning points for IGMH was how we need to handle that more effectively with the media – we didn’t handle that very well at all. It’s in the hands of lawyers now – it was a tragic and very unfortunate case, and a very emotive situation. From the hospital’s perspective we did all the necessary investigations that we needed to do.
JJR: Does it come back to this recurring mistrust of doctors?
CW: That’s one of the things I’ve picked up on – there is this mistrust. We still have to rebuild that, because we have some fantastic doctors and clinical staff in IGMH, and inevitably when we have high profile cases like that it creates more damage for the medical profession, which bore the brunt of that incident. We need to be more proactive about how we talk about some of the great things that happen in the hospital.
I’m not sure Male’ is ready for it, but I’d like to start a patient involvement group – a number of people from the community who work with us to improve what we do in the hospital. We do that a lot in the UK, but I’m not sure people here would be interested in doing that yet. It does help people understand the challenges we face as an organisation on a daily basis.
The President has appointed an envoy to work with the hospital. He has already brought through some significant changes in terms of the environment. It’s looking much better when people come in, and the outpatient area is now air-conditioned.
We need to focus on what we need to do to implement quality of care and improving access – there are hundreds of things need to do, but have to manage expectations.
One of the things we want to introduce is catering – at the moment patients’ relatives have to bring food in for them. That’s so different to the UK – nutrition is so important to a patient’s recovery. We want to try and introduce a catering service before the end of the year, so patients get a better service.
JJR: What are the hospital’s key strengths and weaknesses at the moment, aside from the shortage of mental health support you mentioned earlier?
CW: One area we do need to improve on is diagnostic capacity, and tools for helping diagnose. We are going to get a mammogram machine, which will have the facility to do biopsies, and we are going to get an MRI scanner which will improve diagnostics.
One of the key problems we have is access to equipment and medical consumables. We’ve put new processes and deals in place which will hopefully improve that, but I didn’t realise until I lived here that absolutely everything has to be imported. We are reliant on things coming in a timely way, and I don’t think that just affects us.
We also have a hospital kindly donated by the Indian government, but inevitably the building itself is in need of renovation. It was fit for purpose then but with the influx of people living in Male’ the need for services is huge. We have 500-600 patients a day, sometimes more, and the building is almost too small now. We have to look at how we take care of it and develop a more modern facility.
One of our big concerns in relation to the operating theatre is lack of anaesthetists. We have to pay a premium for them to come, as there’s international shortage. That’s a real problem for delivering key services.
Those are some of the key areas. We have a good team paediatricians, and a very busy but effective neonatal intensive care unit with 20 cots.
JJR: Is it difficult to attract people to come and live and work in the Maldives?
CW: I think it’s becoming more difficult now because of the dollar situation, and the cost of accommodation in Male’. The MHSC provides accommodation to doctors as part of their package, but nevertheless food prices and living expenses are going up.
A big problem is paying people in rufiya – the expats who come and work in the Maldives want to send part of their salary home but banks are struggling to enable them to send dollars. That seems to be a very major problem at the moment.
The big thing is making sure there is the right commitment from expatriates to stay and make a positive difference. There’s got to be some way of making the working conditions right for the Maldivian doctors as well. They are the life of the organisation, and we are dependent on making sure they don’t move elsewhere.
We are in the process of expanding inpatient facilities, and renovating the old staff quarters into more private facilities. We will have 56 beds finished in late summer, and we have also signed an agreement with the 11 storey building next to IGMH to provide 72 beds. This time next year we will have a significant increase in the number of beds, but that brings its own problems, such as where we are going to get staff. We’re trying to make sure there is joined-up thinking going on.
The Indian government has announced the export of 32,094 tonnes of wheat flour to Maldives in 2011-2012, under the bilateral trade pact between the two countries.
India has banned the export of wheat and wheat products to most countries, but allows limited shipments for diplomatic reasons.
The Maldives imports nearly all its food, apart from local staples such as tuna.
Piracy within Indian and Maldivian waters was amongst the issues discussed by President Mohamed Nasheed during a three day visit to the country last week, according to local press reports.
India-based newspaper the Economic Times reported that Nasheed held discussions with local External Affairs Minister Somanahalli Mallaiah Krishna over issues such as trade, as well as methods to extend anti-piracy measures between the two countries to boost security within the Indian Ocean.
The report added that counter-terrorism issues and climate change were also touched upon in the talks with regards to mutual assistance between the two countries in the future.
The president returned from the India visit on Sunday (27 February).
President Mohamed Nasheed has called for the United Nations to deploy peacekeepers in the troubled gulf state of Libya, in an effort “to contain” its leader Muammar Gaddafi.
The Libyan government, a 42 year autocracy under Gaddafi, is facing rising international censure after using African mercenaries and military hardware – including anti-aircraft missiles – against civilian protesters.
At least 300 people are believed dead in the uprising while armed opposition groups now control much of the east of the country including Zawiyah, a town just 30 miles from the west of the capital of Tripoli. The British SAS meanwhile evacuated more than 500 British oil workers from a staging point in the Libyan desert, using C-130 Hercules transports.
“I feel that the UN should now be thinking about peacekeeping in Libya – on the ground intervention. This is very important,” Nasheed said on ‘Walk the Talk’.
“It is very disturbing to see the whole thing being played out, and everyone talking about their nationals – we all humans and sovereignty cannot be played over humanity,” Nasheed said.
“It is very disturbing to hear everyone talking only about their own nationals. People should be talking about Libya and the people. You kill an Indian, you kill a Libyan, what difference does that make? You’ve killed someone.”
Direct action was needed, Nasheed said, rather than the further economic sanctions that had been imposed.
“[The international community] are talking about sanctions – but Libyans already can’t import anything,” he said.
Nasheed noted that Gaddafi had survived the extreme political turbulence of the last 3-4 days, and said he was “very jittery” about the prospects of the leader stepping down voluntarily.
“Certainly he should go – I’ve no doubt about that,” he said. “It is our responsibility to make sure that at the end of the day we don’t have headlines saying 500,000 people are dead from aerial bombing in Libya.”
The Maldives, Nasheed said, was a “laboratory case” for the current call for democracy in the Middle East and the ousting of autocratic leaders.
“For the last 100 years Maldivian leaders have tried to emulate Egypt. There was Gayoom, but other leaders before him also studied in Egypt.
“What they need now are political parties. We will always support movement in any country when people want to be free – it is very important for development that countries haves strong political parties and free and fair elections.”
The uprisings had showcased that there was “no contradiction between Islam and democracy”, Nasheed said. “We are a 100 percent Muslim country and we have been able to galvanise the public for political activism, we’ve been able to amend our constitution, we able to build political parties, we have had free and fair presidential elections, parliamentary elections, local elections, we have separation of powers, we have a very vibrant independent media, we have all the fundamental rights – but all that requires space for organised political activism.”
A theocracy based around an extreme religious idea, Nasheed said, was simply “The camoflage of a standard dictatorship – except in the name of God.”
Issues such as Israel and Middle East peace issues could be more easily dealt with in a free and democratic country, Nasheed said.
“We have been able to have a number contacts with Israel now – the people have no issue with that.”
Queried by the interviewer about the widespread public anger Nasheed faced when reaching out to Israel, Nasheed claimed that “there is always organised opposition, and there should be and we can always talk about it and give our point of view.”
The uprisings had broken many Middle Eastern stereotypes, Nasheed agreed.
“Finally we will be able to show Islam for what it is – a high sophisticated intellectual life, that is highly attractive to people.”
Asked by the interviewer if he himself was “a devout Muslim”, Nasheed described himself as “practicing”, “but I don’t think that necessarily narrows my thinking or my attitude or my interactions with anyone.”
The interviewer also challenged Nasheed on how the Maldives could balance a broadly Islamic population with the influences of Western-style beach tourism.
“Traditionally we were Sufi Muslim, so therefore we were very liberal,” Nasheed said. “But in 70s we had wahabism starting to come in. Then in the late 70s Gayoom came to power, after living in Egypt.
“There was always a tendency to use religion or verses from the Quran or hadiths to justify yourself or justify your actions. Some other leader might have said “for development’. But Gayoom would say, ‘for God, so that we may attain paradise.’ What you are really saying is that you are building a school.”
The government of India is holding a ministerial conference for Least Developed Countries (LDCs) this weekend.
The Maldives will be represented by State Minister of Foreign Affairs, Ahmed Naseem, despite graduating to a Middle Income Country in January.
The number of LDC’s has increased from 25 in 1971 to 48 in 2011, noted the Indian High Commission to the Maldives in a press statement. All countries are expected to be sending their permanent representatives, while 35 ministers are attending the conference in Delhi.
“Sustained global growth and stability will remain a dream if economies of the LDCs continue to be underdeveloped and their natural and human resources remain untapped preventing their overall socio-economic advancement,” the High Commission statement noted.
Indian High Commissioner to the Maldives Dnyaneshwar Mulay and State Foreign Minister Ahmed Naseem have signed a US$5.7 million agreement between the two countries to provide IT assistance to the Maldives.
President Mohamed Nasheed said the agreement would increase the use of technology in the atolls and would be of particular benefit to students.
Furthermore, the Indian government is providing Rf 3.1 million (US$240,000) worth of medical supplies to atoll health centres suffering shortages, and sports equipment worth Rf 2 million (US$155,000).
The Maldives was offered US$85,000 to assist with the “resettlement expenses” of a Guantanamo Bay inmate, sought increased access to “liberal western education” in a bid to tackle growing fundamentalism and vowed that it would “not let relations with India impact relations with the United States.”
These and other diplomatic revelations emerged yesterday with the publication of a leaked diplomatic cable detailing consultations between Washington and the Maldives’ Ambassador to the US, Abdul Ghafoor Mohamed.
Dated February 26 and stamped by US Secretary of State Hilary Clinton, the cable document reports on Ghafoor’s first consultation with US officials on February 23, 2010 ahead of presenting his credentials to US President Barack Obama the following day.
Assistance with UN Human Rights Council seat
According to the cable, Assistant Secretary of State Robert Blake asked Ghafoor about the country’s progress towards gaining a seat on the UN Human Rights Council (which it later obtained).
In response, Ghafoor said he was confident that the Maldives could obtain one of the four Asia Group seats, as he did not believe Iran had enough Arab support. But he expressed concern that a vote split between Thailand and Maldives left the possibility open for Iran to win by “working African capitals.”
“As such, Maldives is not only lobbying Asian missions, but also African missions,” the cable stated.
Blake offered “quiet” US assistance “if it would be helpful”, however Ghafoor said that while he appreciated the offer “the Maldives needed to be seen as earning the seat in its own right.”
“As a small country, [Ghafoor] said, Maldives can’t play other countries against each other; it needs to take principled positions.”
Guantanamo Bay
The cable discusses arrangements for the transfer of a Guantanamo detainee to the Maldives and refers to an individual named ‘Fried’, presumably the Special Envoy to facilitate the closing of Guanatanamo Bay, Daniel Fried.
Information on the matter would be “kept close until we transfer the detainee”, Fried said in the cable, and referred to an offer “of US$85,000 to assist with [the detainee’s] resettlement expenses.”
“Fried stressed the importance of working out more detailed security arrangements for the detainee, along the lines of those applied in other countries that have accepted Guantanamo detainees for resettlement; Embassy Colombo could work directly with the Maldivian government on those arrangements,” the cable stated.
Vulnerability to extremism
Seeking additional US support from the US towards tackling fundamentalism, Ghafoor pressed for increased access to “liberal western education”, which he suggested would also help to combat growing fundamentalist trends.
In the leaked cable, Ghafoor explained that rising fundamentalism stemmed partly from students travelling to places such as Pakistan and Egypt for a free education in Islamic studies, and returning with extremist views. This, he said, had altered the Maldives’ traditionally peaceful and tolerant culture: “‘It used to be simply a question of faith; now you must show that you are more Muslim than others,’ he said.”
The cable also articulated the Maldivian government’s concern about the impact of an attack on an island resort, such as by Somali pirates, which Ghafoor noted “would cripple the country’s economy.”
In response, the US expressed interest in “expanding bilateral defense and security engagement, continuing training, and helping build the Maldives’ maritime security capabilities to counteract the threat from terrorism, piracy, and trafficking.”
Defence probing
Robert Scher, US Deputy Assistant Secretary of Defense for South and Southeast Asia, asked Ghafoor how US military training compared with that of India “in terms of quantity and quality.”
Ghafoor avoided committing to an answer, instead stating that “both were substantive and substantial.”
“Scher indicated that the US did not want to get in the way of Maldivian relationships with its neighbors,” the cable read.
In addition, “Ghafoor assessed that [India’s] perception of the US has evolved and that Male’ would be able to address any concerns. He stated that [the Maldivian] government would not let relations with India impact relations with the United States, reflecting the Maldives’ attempt to ‘show balance’ in the past. Ghafoor replied that, if necessary, Maldives would explain that neither India nor Pakistan need suspect anything ‘untoward’.”
Climate dealing
In a meeting with Deputy Special Envoy for Climate Change Jonathan Pershing, Ghafoor said that the Maldives would like to see small countries at the forefront of the climate debate “receive tangible assistance from the larger economies. Other nations would then come to realize that there are advantages to be gained by compliance.”
Ghafoor then identified several projects including harbour deepening and the strengthening of sea walls that he said would cost “approximately US$50 million.”
“Pershing encouraged Ghafoor to provide concrete examples and specific costs in order to increase the likelihood of bilateral assistance and congressional appropriations,” the cables said.
The Maldivian Ambassador also suggested that President Obama use the “dramatic backdrop” of the Maldives “to deliver a speech on climate change when he next visits the region.”
The airport segment of Indian infrastructure giant GMR has grown become a significant contributor to the company’s revenue, reports financial news website India Infoline, with both the Delhi and Hyderabad airports witnessing stable growth in passenger and cargo volumes.
The company’s airport segment accounts for 40 percent of the firm’s total revenue. With the Male’ airport operations already profitable and with high passenger revenue of $US50 per passenger (compared with US$12 and US$17 per passenger at Delhi and Hyderabad airports), the existing revenue is expected to account for a third of the company’s airport operations.
Male’ International Airport generated US$135 million in revenue last year, Infoline reported, with an operating profit of US$30 million. Being an exotic tourist destination, “air traffic in Male is expected to be steady”, the site added.
GMR has taken debt of US$358 million to complete US$511 million deal to construct a new terminal, and will charge an extra US$25 per passenger, the site reported.
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